Cigarette smoking and nicotine dependence

Addictions, Social Deprivation and Cessation Failure in Head and Neck Squamous Cell Carcinoma Survivors

AIM

To evaluate the evolution of addictions (tobacco and alcohol) and social precarity in head and neck squamous cell carcinoma survivors when these factors are addressed from the time of diagnosis.

METHODS

Addictions and social precarity in patients with a new diagnosis of HNSCC were assessed through the EPICES score, the Fagerström score, and the CAGE questionnaire. When identified as precarious/dependent, patients were referred to relevant addiction/social services.

RESULTS

One hundred and eighty-two patients were included. At the time of diagnosis, an active tobacco consumption was associated with alcohol drinking (Fisher's exact test, p < 0.001). Active smokers were more socially deprived (mean EPICES score = mES = 36.2 [±22.1]) than former smokers (mES = 22.8 [±17.8]) and never smokers (mES = 18.9 [±14.5]; Kruskal-Wallis, p < 0.001). The EPICES score was correlated to the Fagerström score (Kruskal-Wallis, p < 0.001). Active drinkers (mES = 34.1 [±21.9]) and former drinkers (mES = 32.7 [±21]) were more likely to be socially deprived than those who never drank (mES = 20.8 [±17.1]; Krukal-Wallis, p < 0.001). A Fagerström score improvement at one year was associated to a CAGE score improvement (Fisher's exact test, p < 0.001). Tobacco and alcohol consumption were more than halved one year after treatment. Patients who continued to smoke one year after diagnosis were significantly more likely to continue to drink (Fisher's exact test, p < 0.001) and had a significantly higher initial EPICES score (Kruskal-Wallis, p < 0.001).

CONCLUSIONS

At one year, addictions and social deprivation tend to improve when taken care of from the diagnosis. The most dependent patients and those with multiple frailties are at highest risk of cessation failure.

Adverse events of smoking cessation treatments (nicotine replacement therapy and non-nicotine prescription medication) and electronic cigarettes in the Food and Drug Administration Adverse Event Reporting System, 2004-2016

Objectives:

Several smoking cessation treatments (nicotine replacement therapy and non-nicotine prescription medication) and electronic cigarettes are widely used. We evaluated the adverse events related to smoking cessation treatments and electronic cigarettes in the US Food and Drug Administration Adverse Event Reporting System database.

Methods:

We analyzed reports of adverse events associated with smoking cessation treatment and electronic cigarettes terms dated between January 2004 and December 2016. We used the reporting odds ratio with 95% confidence intervals to detect a signal for each adverse event.

Results:

In total, 8,867,135 reports in the Food and Drug Administration Adverse Event Reporting System database were analyzed. The numbers of adverse events for nicotine replacement therapy (transdermal, buccal, oral, and respiratory administration) were 1673, 1016, 425, and 56, respectively. Nicotine replacement therapy (transdermal, buccal, and oral) demonstrated adverse events of nausea, nicotine dependence, and dizziness. For nicotine (transdermal) exposure, the top 5 adverse events reported were nausea (149 cases, reporting odds ratio: 2.28 (95% confidence interval: 1.92–2.69)), dizziness (132 cases, reporting odds ratio: 3.04 (95% confidence interval: 2.54–3.63)), application site erythema (108 cases, reporting odds ratio: 32.52 (95% confidence interval: 26.74–39.55)), headache (98 cases, reporting odds ratio: 1.84 (95% confidence interval: 1.50–2.25)), and dyspnea (94 cases, reporting odds ratio: 1.93 (95% confidence interval: 1.57–2.38)). Many cases of improper use of nicotine replacement therapies were reported. Nausea, depression, abnormal dreams, insomnia, and other adverse events were reported for varenicline. Insomnia, rash, anxiety, and dizziness were reported for bupropion. We observed electronic cigarettes–related adverse events such as dizziness, dyspnea, nausea, heart rate increased, and tremor.

Conclusion:

Our findings suggest that an association exists between nicotine-related adverse events and nicotine replacement therapy. Healthcare professionals should closely monitor smokers trying to quit nicotine use for the misuse of nicotine replacement therapy. These findings may be informative to healthcare professionals in order to improve the management of smoking cessation treatment.

Current status on biochemistry and molecular biology of microbial degradation of nicotine

Bioremediation is one of the most promising methods to clean up polluted environments using highly efficient potent microbes. Microbes with specific enzymes and biochemical pathways are capable of degrading the tobacco alkaloids including highly toxic heterocyclic compound, nicotine. After the metabolic conversion, these nicotinophilic microbes use nicotine as the sole carbon, nitrogen, and energy source for their growth. Various nicotine degradation pathways such as demethylation pathway in fungi, pyridine pathway in Gram-positive bacteria, pyrrolidine pathway, and variant of pyridine and pyrrolidine pathways in Gram-negative bacteria have been reported. In this review, we discussed the nicotine-degrading pathways of microbes and their enzymes and biotechnological applications of nicotine intermediate metabolites.

The Young Adults' Cigarette Dependence (YACD) score: an improved tool for cigarette dependence assessment in university students

BACKGROUND

Cigarette smoking induces dependence in young smokers.

PURPOSE

The primary objective of this work was to validate the use of the Fagerström Test for Nicotine Dependence (FTND) in young Lebanese university students, and to improve it eventually by adding new items covering DSM-IV and ICD-10 dependence components.

METHODS

We used data from a cross-sectional study on university students. A standardized questionnaire was administered, with items related to cigarette dependence: the FTND and the new Young Adults' Cigarette Dependence (YACD) scale. For both tools, factor and reliability analyses were performed.

RESULTS

Although the FTND test showed satisfactory psychometric properties, the YACD showed better construct validity and reliability, covered dependence concept better and discriminated better between those who wanted to stop smoking and those who did not.

CONCLUSIONS

FTND could be used in university students' population; however, the YACD scale could be more useful.

The Lebanese Cigarette Dependence (LCD) Score: a comprehensive tool for cigarette dependence assessment

BACKGROUND

Cigarette smoking induces dependence.

PURPOSE

The primary objective of this work was to validate the use of the Fagerström test for nicotine dependence (FTND) in the Lebanese population, and to broaden it eventually by adding new items covering DSM-IV and ICD-10 dependence components.

METHODS

We used data from two samples: a cross-sectional national study and a case-control study. A standardized questionnaire was administered, with items related to cigarette dependence: the FTND and the new Lebanon Cigarette Dependence (LCD) scale. For both tools, an exploratory factor analysis was performed on sample 1, while confirmatory factor analysis was performed on sample 2.

RESULTS

Although the FTND test showed satisfactory psychometric properties, the LCD showed better validity and reliability, covered dependence concept better, and showed a higher correlation with the number of times the participant tried to stop smoking (r = -0.087; p = 0.029 versus r = -0.215; p < 0.001).

CONCLUSIONS

FTND could be used in the Lebanese population; however, the LCD scale may be more useful.

Adherence to varenicline and abstinence rates for quitting smoking in a private health promotion center-based smoking cessation clinic

BACKGROUND

Varenicline is an effective smoking cessation aid. However, smokers prescribed with varenicline do not always receive varenicline for 12 weeks, as recommended. This study analyzed the subjects who received varenicline and investigated the effect of varenicline treatment duration on the success rate of 6-month smoking cessation.

METHODS

This study retrospectively analyzed 78 subjects, who received varenicline, out of the 105 smokers that had visited the smoking cessation clinic after medical examination from September 2007 to December 2009.

RESULTS

The subjects were all males. Twenty-two subjects (28.2%) had varenicline treatment for 12 weeks or longer; 18 subjects (23.1%) for 8~12 weeks; 22 subjects (28.2%) for 4~8 weeks; and 16 subjects (20.5%) for less than 4 weeks. The total success rate of the 6-month smoking cessation was 47.4%. The success rate of the 6-month smoking cessation was 63.6% in the group that received varenicline for 12 weeks or longer, which was higher than 41.1% of the group that early terminated the varenicline treatment (p=0.074). The period of varenicline treatment was extended for one more week, the odds ratio of the 6-month smoking cessation success increased to 1.172-folds (p=0.004; 95% confidence interval, 1.052~1.305). Adverse events occurred in 30.8% of the subjects who received varenicline, but no serious adverse events were found.

CONCLUSION

If varenicline treatment period is extended, the odds ratio of the success rate for the 6-month smoking cessation increases. Therefore, an effort to improve drug compliance for varenicline in clinical practices could be helpful for the long-term success of smoking cessation.

University of São Paulo Reasons for Smoking Scale: a new tool for the evaluation of smoking motivation

OBJECTIVE

To develop a new scale aimed at evaluating smoking motivation by incorporating questions and domains from the 68-item Wisconsin Inventory of Smoking Dependence Motives (WISDM-68) into the Modified Reasons for Smoking Scale (MRSS).

METHODS

Nine WISDM-68 questions regarding affiliative attachment, cue exposure/associative processes, and weight control were added to the 21 questions of the MRSS. The new scale, together with the Fagerström Test for Nicotine Dependence (FTND), was administered to 311 smokers (214 males; mean age = 37.6 ± 10.8 years; mean number of cigarettes smoked per day = 15.0 ± 9.2), who also provided additional information. We used exploratory factor analysis in order to determine the factor structure of the scale. The influence that certain clinical features had on the scores of the final factor solution was also analyzed.

RESULTS

The factor analysis revealed a 21-question solution grouped into nine factors: addiction, pleasure from smoking, tension reduction, stimulation, automatism, handling, social smoking, weight control, and affiliative attachment. For the overall scale, the Cronbach's alpha coefficient was 0.83. Females scored significantly higher for addiction, tension reduction, handling, weight control, and affiliative attachment than did males. The FTND score correlated positively with addiction, tension reduction, stimulation, automatism, social smoking, and affiliative attachment. The number of cigarettes smoked per day was associated with addiction, tension reduction, stimulation, automatism, affiliative attachment, and handling. The level of exhaled CO correlated positively with addiction, automatism, and affiliative attachment.

CONCLUSIONS

The new scale provides an acceptable framework of motivational factors for smoking, with satisfactory psychometric properties and reliability.

Gender-stratified gene and gene-treatment interactions in smoking cessation

We conducted gender-stratified analyses on a systems-based candidate gene study of 53 regions involved in nicotinic response and the brain-reward pathway in two randomized clinical trials of smoking cessation treatments (placebo, bupropion, transdermal and nasal spray nicotine replacement therapy). We adjusted P-values for multiple correlated tests, and used a Bonferroni-corrected α-level of 5 × 10(-4) to determine system-wide significance. Four single-nucleotide polymorphisms (rs12021667, rs12027267, rs6702335, rs12039988; r2 > 0.98) in erythrocyte membrane protein band 4.1 (EPB41) had a significant male-specific marginal association with smoking abstinence (odds ratio (OR) = 0.5; 95% confidence interval (CI): 0.3-0.6) at end of treatment (adjusted P < 6 × 10(-5)). rs806365 in cannabinoid receptor 1 (CNR1) had a significant male-specific gene-treatment interaction at 6-month follow-up (adjusted P = 3.9 × 10(-5)); within males using nasal spray, rs806365 was associated with a decrease in odds of abstinence (OR = 0.04; 95% CI: 0.01-0.2). While the role of CNR1 in substance abuse has been well studied, we report EPB41 for the first time in the nicotine literature.

Modified Reasons for Smoking Scale: translation to Portuguese, cross-cultural adaptation for use in Brazil and evaluation of test-retest reliability

OBJECTIVE

To translate the Modified Reasons for Smoking Scale (MRSS) to Portuguese, to submit it to cross-cultural adaptation for use in Brazil and to evaluate the test-retest reliability of the translated version.

METHODS

An English-language version of the MRSS was translated to Portuguese by Brazilian doctors who have thorough knowledge of the English language. A consensus version was produced by a multidisciplinary group including two pulmonologists, a psychiatrist and a psychologist. This version was back-translated to English by an American translator. Cross-cultural adaptation of the final version was evaluated in a sample of 20 healthy smokers. Test-retest reliability was evaluated by applying the translated version of the scale in 54 healthy smokers on two distinct occasions, 15 days apart.

RESULTS

This translated version of the MRSS was well understood by 95% of the smokers, indicating excellent cross-cultural equivalence. The degree of reliability of the answers in two different occasions was almost perfect for two questions, substantial for ten questions, moderate for eight questions, and low for one question. The intraclass correlation coefficients of the motivational factors obtained on the two different occasions, calculated according to previously published theoretical models, were higher than 0.7 for six of the seven subscales.

CONCLUSIONS

The Portuguese-language version of the MRSS shows satisfactory cross-cultural equivalence and test-retest reliability. It can be a useful tool in the evaluation and treatment of smokers in Brazil.

Nicotine Replacement Therapy for Tobacco Use Cessation

Tobacco use is the leading preventable cause of morbidity and mortality in the United States. Nicotine replacement therapy (NRT) remains a first-line pharmacotherapy for tobacco and smoking cessation. Five formulations of NRT for delivery of nicotine were approved by the US Food and Drug Administration between 1984 and 2002, including 3 available without prescription from pharmacies. A table was created as a tool for pharmacists to counsel patients about the NRT products. The table summarizes available doses, dosing regimen and schedules, administration technique, contraindications, and adverse effects.